Navigating COVID-19 Surges: A Case Study of a Hospital-at-Home Implementation

This study documents the experience of implementing an adaptation of the Hospital-at- Home (HaH) modelto alleviate the constraints in available hospital beds and manpower amid a surge in infection rates in Singapore during the Omicron and XBB COVID waves, addressing challenges and proposing insights for scalable implementation. HaH substitutes inpatient hospitalizations by leveraging existing community healthcare services and remote healthcare technologies. This HaH adaptation was designed to be activated in during surges and deactivated when bed and manpower demands stabilize, making it less intensive on hospital resources. HaH demonstrated success in facilitating safe early discharge and admission avoidance for high-risk patients, reducing hospital bed utilization without reducing care quality. However, challenges including lack of technological literacy, language barriers, and miscommunications resulting from clerical errors were experienced. Our findings suggest that hospitals with internal resource constraints can make adaptations to leverage existing providers and assets within the community where necessary. We also observed that HaH shifts many aspects of healthcare responsibility to patients and their caregivers, which may be beyond their expected capabilities. Clear communication of expectations and limitations from all parties involved is paramount to upholding the quality of care in HaH.